Pathological Conditions, Signs and Symptoms Commons^™

A True Bloody Emergency: An Unusual Case Of Thrombotic Thrombocytopenic Purpura, Joshua M. Ninan

Research Symposium

Background: Thrombotic thrombocytopenic purpura (TTP) is a primary thrombotic microangiopathy that is classically characterized by thrombocytopenia and microangiopathic hemolytic anemia (MAHA). Although rare with an annual incidence of 3.7 cases per one million adults, it is considered a true hematological emergency due to its fatality rate of almost 100% if appropriate treatment is not initiated immediately. This makes it vitally important to identify and treat patients with TTP, a task that becomes unusually challenging in the absence of the disorder’s other characteristically diagnostic clinical features such as mucosal bleeding, fever, or presence of schistocytes.

Case Presentation: A 30-year-old gentleman with …

Dietary Analysis For Hashimoto’S Thyroiditis: An Integrative Review, Evan Thompson, Alison Hultquist

Master of Science in Nursing Final Projects

Abstract

Hashimoto’s Thyroiditis (HT) is the leading cause of primary hypothyroidism in the United States. In HT, there is an infiltration by lymphocytes which leads to the production of autoantibodies against the thyroid gland. Throughout this integrative review, the aim was to evaluate the effectiveness of micronutrient supplementation and dietary management as adjunct treatments in HT. The purpose was to assist primary care providers in the development of a more holistic plan of care. Literature published within the past seven years was gathered and reviewed from PubMed, CINAHL, and Cochrane Library. Findings indicate that many patients with HT may benefit …

Improving Diabetic Retinopathy Screening Practices With Qi Methodology In Family Medicine Offices, Rea Isaac, Anne Jones

Rowan-Virtua Research Day

Early detection and treatment of diabetic retinopathy (DR) is crucial in preventing vision loss and blindness in vulnerable diabetics. With around 7.7 million patients having DR, and the target population being 20 -75 years old, the potential for improving their quality of life is substantial (WHO, 2022). Despite the importance of timely and routine eye exams, 45% of diabetic patients do not complete an exam despite physicians recommendations (Lu, 2014). This project aims to standardize eye exams, improve process flow, and improve patient understanding of the urgency of timely and comprehensive eye exams for DR. Multiple PDSA cycles and QI …

Mixed Beri’S: High Output Heart Failure From Severe Anemia And Thiamine Deficiency, Rohan Umrani, Hiral Amin, Ashley Pinckney, Charles Yang, Daniel Tran

Rowan-Virtua Research Day

Background: Severe anemia and thiamine deficiency can independently result in high output heart failure (HOHF) through different mechanisms. Data on the threshold and timeframe at which these etiologies may precipitate HOHF is unclear.

Case: A 63-year-old male with alcohol use disorder consuming 18 drinks/week presented with progressive shortness of breath and lower extremity edema for a few months. Physical exam revealed tachycardia, anasarca, jugular venous distension, Lancisi’s sign, and a midsystolic murmur. Echocardiogram demonstrated EF of 30-35%, dilated left ventricle, and cardiac index of 4.2L/min/m2.

Decision-Making: Heart failure can independently precipitate anemia while severe alcoholism can induce myelosuppression and promote …

The Clinical Definition And Characterization Of Field Of Cancerization In Patients With Actinic Keratoses, Stuti Prajapati, Christina Kontzias, Mallory Zaino, Steven Feldman

Rowan-Virtua Research Day

Introduction: Chronic UV radiation affects the entire area of skin exposed, leading to visible actinic keratoses (AK) and subclinical changes in the surrounding skin. AKs are hyperkeratotic lesions, with a 0.025-16% risk of transforming into squamous cell carcinoma (SCC).1 Cellular atypia around AKs is the field of cancerization (FOC). Topical AK therapies can treat the FOC, while destructive treatments address visible lesions. FDA-approved products may be approved for field sizes up to 25 cm2.1,2

Objective: To characterize the FOC and assess the correlation between the FOC and number of AKs.

Methods: 100 patients with AKs were recruited. FOC was defined …

Herpesviriae Infection Of The Corneal Endothelium, Behnam Rabiee, Chandani Patel, Mansab Jafri, Hamad Hussain, Michael Gaspari, Muhamad Festok, Imtiaz Chaudhry, Iftikhar Chaudhry, Asim Farooq

Rowan-Virtua Research Day

Background

- The corneal endothelium plays a vital role in maintaining corneal clarity by regulating the amount of fluid in the corneal stroma.

- Corneal endotheliitis is defined as inflammation of the corneal endothelial layer that leads to corneal edema and haziness, and subsequent loss of vision.

- Most common causes include cytomegalovirus (CMV), herpes simplex virus (HSV), and varicella zoster virus (VZV).

- Because corneal endothelial cells cannot regenerate following injury, early diagnosis is essential in proper management and preventing loss of corneal endothelial cells.

In this review we aim to gather the most recent knowledge on viral corneal …

Case Report: Use Of Bedside Handheld Ultrasound To Diagnose Finger Dislocation, Frank Wheeler, Philip Carhart, James Espinosa, Alan Lucerna, Henry Schuitema

Rowan-Virtua Research Day

Here we present the case of a 37-year-old male with a finger injury in which finger dislocation was suspected clinically. A bedside pocket ultrasound was performed using a water submersion technique, which identified a posterior dislocated right 2nd digit at the PIP joint. This finding was confirmed with an x-ray. This case report demonstrates that ultrasonography can be utilized to correctly identify finger dislocation. Although larger studies need to be performed to validate the accuracy of this imaging technique, the implications may improve care of the patient. It would also be particularly beneficial for this technique to be applied to …

Pathophysiology, Presentation, And Management Of Interstitial Cystitis In The Acute Setting, David Koziel

Rowan-Virtua Research Day

Interstitial cystitis (IC) also known as bladder pain syndrome (BPS) and more infrequently by other monikers represents a debilitating disease with a poorly understood pathophysiology. According to the Centers for Disease Control the incidence of IC ranges from 1 to 5.1 cases per 100,000 individuals. While a relatively rare condition, it is common enough that the provider in the acute setting recognizes the pathophysiology and is familiar with the management of this condition. It is a disease that is more prevalent in women, however men can also be affected. Due to the significant overlap with more common conditions, it is …

Importance Of Serial Ekgs In The Emergency Room Setting, Swet Patel, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Chest pain is one of the most common chief complaints that presents to the emergency department. More than 8 million patients with chest related complaints present each year with about 10% of all ED visits comprise of cardiovascular emergencies. Immediate evaluation is the standard of care to differentiate between life threatening conditions and non-life threatening ones with the use of 12-lead electrocardiograph (EKG) and bedside monitors. The 12 lead EKG remains gold standard for initial screening and evaluating patients with chest pain and angina equivalents. The test is fairly inexpensive and noninvasive with providing vital information about cardiac rhythm. The …

Brash Syndrome Case Report And Brief Review, Kelly Schuitema

Rowan-Virtua Research Day

BRASH syndrome is an acronym that stands for bradycardia, renal failure, AV node blocker, shock and hyperkalemia. The syndrome is precipitated by synergism from AV nodal blocking agents and hyperkalemia. The combination of the AV nodal blockade and renal failure leads to a cycle of severe bradycardia and hyperkalemia. We will discuss a case of BRASH syndrome with a 68 year old female who presented with generalized weakness and was found to be hypotensive, bradycardia, in acute renal failure with hyperkalemia likely related to metoprolol and amlodipine use.

A 5-Year Clinical Course Of Phenocopy Syndrome Of Behavioral Variant Frontotemporal Dementia: Case Report And Literature Review, Joseph Melillo, Keyur Patel, Christian White

Rowan-Virtua Research Day

Frontotemporal dementia is a neurocognitive disease which affects language, behavior, or executive functioning. This disease includes a spectrum of presentations which includes multiple variants. The phenocopy syndrome of behavioral variant frontotemporal dementia is one which mimics the behavioral variant of frontotemporal dementia. Patients with this condition show a decline in personality, social conduct and cognitive ability but often display no signs of neurological imaging and exhibit slow progression. This case focuses on a now 70-year-old male who has shown signs of behavioral changes with a slowly progressive clinical course and minimal findings on PET scan, but moderate changes seen on …

Case Report And Brief Review: A Case Of Erythema Ab Igne Due To A Space Heater, Adam Kandil, James Espinosa, Alan Lucerna, James Lee, Robin Lahr

Rowan-Virtua Research Day

A 35 year old male presented to the Emergency Department (ED) with a rash of his left lateral lower leg of a 2 months duration. The patient had been using an electric space heater and the affected area was the closest part of his body to the heater. A diagnosis of erythema ab igne was made. Here we discuss erythema ab igne in reference to the medical history of the diagnosis, pathophysiology, modern causative heat sources such as laptop computers and treatment.

New Onset Lichen Planus And Back Pain Leading To Discovery Of A Peri Aortic Abscess, Monica Diep, Wayne Tamaska, Philip Carhart, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Back pain is a common chief complaint in the emergency department. With the differential ranging from musculoskeletal pain to cauda equina, there are a plethora of diagnoses. Differentiating between benign back pain and back pain that warrants further evaluation and even possible emergent surgical intervention is often a challenge in the acute setting. In this case report, a strange combination of all new symptoms including lichen planus, fevers, chills and atraumatic back pain lead to the eerie and very unexpected diagnosis of a peri-aortic abscess.

Barriers To Colorectal Cancer Screening For Low-Income Hispanic Men In Urban Areas Between 50-75, Alex Vega

Rowan-Virtua Research Day

Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Although CRC screening rates have improved in non-Hispanic whites (NHW), Hispanic adult males (HAM) aged 50-75 in urban areas continue to experience low screening rates and higher CRC morbidity and mortality. This review aims to identify the barriers to CRC screening among HAM and propose targeted interventions to increase screening rates. A comprehensive literature review was conducted using databases such as PubMed, Scopus, and Google Scholar. Key search terms included "colorectal cancer", "screening", "Hispanic adult males", "urban", "barriers", and "interventions". Factors identified include poverty, language …

Case Report: Carbon Monoxide Poisoning: A Sleuth, Joel Collins, Wayne Tamaska, Anna Barton, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 18 year old male who presented via EMS who was called for an unconscious male in his car diagnosed initially with opioid overdose and later found to have carbon monoxide poisoning. The differential diagnosis of carbon monoxide poisoning is someone broad and non specific, but in general, carbon monoxide poisoning can be initially elusive in diagnosis and requires continued consideration. This remains true especially in this case of an unconscious male with initial responsiveness to naloxone. It is predictable that as with time the preponderance and relative commonality of this condition will decrease with …

Obstructive Hydrocephalus Caused By A Colloid Cyst Presenting As A Transient Ischemic Attack (Tia), Muhammad Nadeem

Rowan-Virtua Research Day

Colloid cysts are benign growths commonly found in the third ventricle or at the Foramen of Monroe. They are composed of epithelial lining filled with gelatinous material that contain cholesterol, mucin, old blood and ions. Most colloid cysts are asymptomatic but can present with a variety of symptoms that range from headaches, diplopia, memory problems, and vertigo. They can also present as an obstructive hydrocephalus with the classic “Wet, wacky and wobbly” triad. Rarely colloid cysts have been reported to cause sudden death. They can present to the ED with any spectrum of these symptoms.

An Unusual Ed Case: Spontaneous Necrotizing Fasciitis Presenting As Hypoxic Pneumonia, Chetna Thawani, Kishan Patel

Rowan-Virtua Research Day

We present a case of necrotizing fasciitis initially presenting as septic hypoxic pneumonia, and discuss imaging modalities and diagnostic evaluation. Necrotizing soft tissue infection (NSTI) is a rapidly progressive surgical emergency with a mortality rate of 30%. In approximately 80% of cases, it is introduced through a break in the skin. It can also occur after any invasive procedure or surgery. It is most commonly associated with skin flora including staph and strep, though polymicrobial infections are most common. It usually presents with signs of systemic infection, including fever, chills, sepsis, altered mental status - and signs of cutaneous involvement …

Case Report: Vocal Cord Paralysis In The Ed, Richard Baluyot, Russell Mordecai, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

The incident rate of vocal cord paralysis varies greatly depending on the cause of paralysis as well as if it's unilateral or bilateral, for this poster we will be focusing on unilateral paralysis. From 1985 to 1995 cancer was the primary cause for vocal cord paralysis, however this shifted to primarily iatrogenic surgical injury from 1996 to 2005. In another study it was found that idiopathic paralysis and tumors to both be the primary cause (31.11% respectively), with surgery consisting of 28.89%, and trauma, brain problems, systemic disease and other causes being 2.2%.

Spontaneous Iliac Arteriovenous Fistula, High-Output Heart Failure, And Cardiac Arrest, J. Maxwell Piraneo, Russell Mordecai, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

High-output heart failure is a potentially life-threatening condition that can lead to cardiac arrest. The most common causes of this condition are obesity, liver disease, arteriovenous shunts, lung disease, and myeloproliferative disorders, however the exact prevalence remains uncertain [1]. Here we describe an unusual case of cardiac arrest as a consequence of high-output heart failure, secondary to rupture of an iliac artery aneurysm into the common iliac vein, with arteriovenous (AV) fistula formation.

Case Report: Cavitary Pneumonia In A 28 Year Old Male, Dan Zaayenga, Katelyn Courtney

Rowan-Virtua Research Day

Cavitary pneumonia can be caused by several different mechanisms. Such causes include suppurative necrosis (pyogenic lung abscess), caseous necrosis (tuberculosis), ischemic necrosis (pulmonary infarction) cystic dilatation of lung structures (ball value obstruction and Pneumocystis pneumonia) as well as malignant processes. Causes are subject to both environmental factors and host susceptibility. The most common cause of infectious process is tuberculosis with its propensity to cause extensive caseous necrosis. The potential for secondary infection after an individual develops a cavitary pneumonia is also great as it provides a shelter for various pathogens the flourish in an environment otherwise usually well-guarded by host …

Case Study Of Horner Syndrome Due To Internal Carotid Artery Dissection, Kajel Patel

Rowan-Virtua Research Day

Carotid artery dissection can occur either spontaneously or because of trauma. It is usually the most common cause of stroke in middle-aged patients. The symptoms can be transient or persistent and typically occur a few days after the inciting traumatic event.

Correlation Between Gut Biomarkers And Depression, Jianle Gao

Rowan-Virtua Research Day

The correlation between the gut-microbiota- brain axis and mental state in the context of mental disorders such as Major Depressive Disorder (MDD), Schizophrenia, etc. has been well studied. Production of inflammatory and non-inflammatory metabolites by the gut- microbiota directly and indirectly affects the brain and mood. Therefore, colonization by maladaptive, pro-inflammatory bacteria may cause mood dysregulation and depressive features. Metabolites from these bacteria can be quantitatively analyzed for use as biomarkers of Major Depressive Disorder. Biomarkers studied include: serotonin, dopamine, butyrate, acetate, and propionate.

Case Study: Posterior Reversible Encephalopathy Syndrome (Pres) In A Stroke Patient With Seizures, Akhmad Ernazarov, Shikhar Manchanda, Yvette Wang

Rowan-Virtua Research Day

Posterior Reversible Encephalopathy Syndrome (PRES) is a condition in which patients present with visual disturbances, headaches, seizures, and impaired consciousness. It can affect a wide variety of patients ranging from infants to elderly, but young and middle aged adults are most commonly affected; females are more likely to be affected by PRES than males. Risk factors such as hypertension, pre-eclampsia/eclampsia, renal failure, cytotoxic conditions and autoimmune conditions predispose patients to PRES. In this unique case, a 63 female patient was admitted to Jefferson Washington Hospital exhibiting classic stroke like symptoms. Patient also began seizing in the ED which was unusual …

Purple Urine Bag Syndrome (Pubs) In A Patient With A Chronic Indwelling Foley, Kelsey Murray, Kishan Patel

Rowan-Virtua Research Day

Purple urine bag syndrome (PUBS) is a rare medical condition characterized by the appearance of purple discoloration in the urine collection bag of patients who use catheters for urinary drainage. PUBS is primarily seen in elderly, female, and institutionalized patients who have chronic indwelling catheters. The discoloration occurs due to the presence of certain bacteria that produce pigments, which react with the plastic materials of the catheter and urine collection bag, leading to the formation of a purple color. In addition to the aesthetic concerns, PUBS may also indicate an underlying urinary tract infection or other medical conditions that require …

Dissociating Statistically Determined Normal Cognitive Abilities And Mild Cognitive Impairment Subtypes With Dctclock., Emily F. Matusz, Catherine C. Price, Melissa Lamar, Rod Swenson, Rhoda Au, Sheina Emrani, Victor Wasserman, David J Libon, Louisa I. Thompson

Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship

OBJECTIVE: To determine whether the DCTclock can detect differences across groups of patients seen in the memory clinic for suspected dementia.

METHOD: Patients (n = 123) were classified into the following groups: cognitively normal (CN), subtle cognitive impairment (SbCI), amnestic cognitive impairment (aMCI), and mixed/dysexecutive cognitive impairment (mx/dysMCI). Nine outcome variables included a combined command/copy total score and four command and four copy indices measuring drawing efficiency, simple/complex motor operations, information processing speed, and spatial reasoning.

RESULTS: Total combined command/copy score distinguished between groups in all comparisons with medium to large effects. The mx/dysMCI group had the lowest total …

Magnetic Resonance Imaging-Derived Microvascular Perfusion Modeling To Assess Peripheral Artery Disease, Olga A. Gimnich, Tatiana Belousova, Christina M. Short, Addison A. Taylor, Vijay Nambi, Joel D. Morrisett, Christie M. Ballantyne, Jean Bismuth, Dipan J. Shah, Gerd Brunner

School of Medicine Faculty Publications

BACKGROUND: Computational fluid dynamics has shown good agreement with contrast-enhanced magnetic resonance imaging measurements in cardiovascular disease applications. We have developed a biomechanical model of microvascular perfusion using contrast-enhanced magnetic resonance imaging signal intensities derived from skeletal calf muscles to study peripheral artery disease (PAD). METHODS AND RESULTS: The computational microvascular model was used to study skeletal calf muscle perfusion in 56 in-dividuals (36 patients with PAD, 20 matched controls). The recruited participants underwent contrast-enhanced magnetic resonance imaging and ankle-brachial index testing at rest and after 6-minute treadmill walking. We have determined associations of microvascular model parameters including the transfer …

Estimating Dementia Risk In An African American Population Using The Dctclock, Marissa Ciesla, Jeff Pobst, Joyce Gomes-Osman, Melissa Lamar, Lisa L Barnes, Russell Banks, Ali Jannati, David Libon, Rodney Swenson, Sean Tobyne, David Bates, John Showalter, Alvaro Pascual-Leone

Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship

The prevalence of Alzheimer's disease (AD) and related dementias (ADRD) is increasing. African Americans are twice as likely to develop dementia than other ethnic populations. Traditional cognitive screening solutions lack the sensitivity to independently identify individuals at risk for cognitive decline. The DCTclock is a 3-min AI-enabled adaptation of the well-established clock drawing test. The DCTclock can estimate dementia risk for both general cognitive impairment and the presence of AD pathology. Here we performed a retrospective analysis to assess the performance of the DCTclock to estimate future conversion to ADRD in African American participants from the Rush Alzheimer's Disease Research …

Classification Of Breast Cancer Histopathological Images Using Semi-Supervised Gans, Balaji Avvaru, Nibhrat Lohia, Sowmya Mani, Vijayasrikanth Kaniti

SMU Data Science Review

Breast cancer is diagnosed more frequently than skin cancer in women in the United States. Most breast cancer cases are diagnosed in women, while children and men are less likely to develop the disease. Various tissues in the breast grow uncontrollably, resulting in breast cancer. Different treatments analyze microscopic histopathology images for diagnosis that help accurately detect cancer cells. Deep learning is one of the evolving techniques to classify images where accuracy depends on the volume and quality of labeled images. This study used various pre-trained models to train the histopathological images and analyze these models to create a new …

A Review Of The Pathogenesis, Clinical Features And Diagnostic Indicators Of The Novel Condition Vaccine-Induced Thrombotic Thrombocytopenia, Ada Fleming

International Undergraduate Journal of Health Sciences

The introduction of vaccination against SARS-CoV-2 infection was a welcome and significant event in the COVID-19 pandemic. While vaccine administration was for the most part successful, it did come with the emergence of a novel condition, Vaccine-Induced Thrombotic Thrombocytopenia (VITT). This condition presents after the administration of adenoviral vector-based vaccines against COVID-19, causing thrombocytopenia and thrombosis in affected individuals. There have been 10 suspected cases of VITT in Ireland. While its mechanism is not fully understood, the condition is characterised by the presence of Platelet Factor 4 (PF4) antibodies. There are several laboratory indicators which may suggest that a patient …

An Updated Patient-Centered Sialadenitis Instrument: The Obstructive Salivary Problem Impact Test (Spit), Arushi Gulati, David M. Cognetti, David S. Cohen, M. Allison Ogden, Barry M. Schaitkin, Rohan R. Walvekar, William R. Ryan, Jolie L. Chang

School of Medicine Faculty Publications

Objective: The Chronic Obstructive Sialadenitis Symptoms questionnaire (COSS) was created to assess chronic sialadenitis symptoms and treatment response, but its development lacked patient input and validation. We analyzed COSS responses and feedback from sialadenitis patients and physician experts to create the novel obstructive Salivary Problem Impact Test (SPIT), a new standardized measure of sialadenitis-associated symptoms. Methods: We analyzed COSS responses via exploratory factor analysis (EFA) to identify essential symptom domains and reduce overlap in questions. Sialadenitis patients evaluated the significance of index symptoms identified from the literature review. Expert physicians rated symptom relevance in clinical assessment. An updated questionnaire (SPIT) …